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Stromal Lenticule Addition Keratoplasty (SLAK)

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Modern Keratoplasty

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

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Abstract

In the past decades, femtosecond laser (FSL) became a valuable ophthalmic surgical tool for the refractive surgeon. Thanks to the capability of dissecting transparent tissues and creating complex cut geometry, FSL leads to the introduction of a new type of refractive surgery procedure called refractive lenticule extraction. The nondestructive approach of lenticule subtraction rather than photoablation of these techniques has made it possible to obtain a whole new source of stromal tissues not available before. Extracted lenticules maintain the vitality and transparency and can be stored and reused for further procedures. The use of these FSL-dissected lenticules has renewed the old additive approach of “stromal keratophakia” for the correction of refractive errors. Recent studies showed that lenticules maintain their structure after implantation into the recipient corneal stroma and effectively change the corneal curvature with sufficient predictability. Despite the possible use of lenticules for correcting refractive errors, the interest in remodeling the cornea in ectatic disorders is of particular interest. The progressive stromal thinning and corneal protrusion in keratoconus leading to severe irregular astigmatism occur in the majority of cases maintaining the corneal transparency. Therefore, the surgical management of keratoconus with keratoplasty, in which the whole stroma is replaced, may become unnecessary by borrowing the principles of novel stromal keratophakia concept, such as lenticule implantations by the aid of FSL. Stromal lenticule addition keratoplasty has been proposed as an additive keratoplasty approach by using negative meniscus lenticule to reduce central corneal curvature and in the meantime increase corneal thickness in cases of moderate ectasia. The first ex vivo study proved good predictability of curvature changes in normal donor cornea, while the subsequent human case series in advanced keratoconus showed that lenticules induce central corneal flattening, integrate into the corneal stroma, and maintain transparency over time. Future perspectives include customization of lenticules to be implanted and the possibility of banking cryo-preserved lenticules for clinical use.

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Authors and Affiliations

  1. National High-Tech Eye Center, University of Chieti and Pescara, Chieti, Italy

    Leonardo Mastropasqua, Manuela Lanzini & Mario Nubile

  2. Department of Translational Medicine, University of Ferrara, Ferrara, Italy

    Niccolò Salgari

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  1. Leonardo Mastropasqua
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  1. Vissum Miranza, Miguel Hernández University, Alicante, Spain

    Jorge L. Alió

  2. Vissum-Instituto Oftalmologico de Alica, Miguel Hernandez University, Alicante, Alicante, Spain

    Jorge L. Alió del Barrio

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The surgical procedure starts with the creation of the donor lenticule and the intra-stromal pocket into the recipient cornea by means of femtosecond laser. After dissection, lenticule is transferred to the recipient cornea and inserted through the incision and spread out with a dedicated forceps. Final position and distention are achieved by gentle manipulation of the corneal surface (MP4 21,956 kb)

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Mastropasqua, L., Salgari, N., Lanzini, M., Nubile, M. (2023). Stromal Lenticule Addition Keratoplasty (SLAK). In: Alió, J.L., del Barrio, J.L.A. (eds) Modern Keratoplasty. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-031-32408-6_19

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